Claim total
$174.40
base $93.39 · payer covered $24.40
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2020-12-30
- Stop
- 2020-12-30
The parties
- Patient
- patient Ronald Inga Torphy
- Provider
- provider Josh Stamm
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
05af61d0-e78c-a60a-eb9e-063cd942cf44